Basic Guideline Information Only
Explanation of troublesome PSA issues
High PSA levels may be the first sign of prostate cancer however, only 25% of cases with a PSA of 4 to 10 are cancerous on average. Other, less serious conditions are much more common causes of abnormally high PSA values.
Earlier this year, members of the United States Preventive Services Task Force (USPSTF) released guidelines recommending against prostate specific antigen (PSA) testing in healthy men — that is, men who have no family history, known risk factors, or symptoms of prostate cancer.
One reason they cited was the fact that the test can’t distinguish between serious causes of elevated PSA levels (such as cancer) and other causes (such as a urinary tract infection).
PSA tests measure a protein in your blood called prostate specific antigen, or PSA. Prostate cancer makes PSA levels go higher, but high PSAs aren’t always a sign of prostate cancer.
Sometimes, readings may be elevated because of something benign, such as ejaculating within 24 hours of the test.
Your “normal” PSA depends on your age, but even if your PSA level is elevated between 4 and 10, you have only about a 25 percent chance of prostate cancer.
Here are some reasons, besides prostate cancer, that your PSA level could be above normal.
High PSA Levels From Prostatitis
“The PSA test is a good screening tool for prostate cancer, but it is not very specific,” says Erik P. Castle, MD, FACS, an associate professor of urology at the Mayo Clinic. “Common causes of inflammation in the gland, called prostatitis, can cause high PSA levels.”
Prostatitis caused by bacteria can be treated with antibiotics. Another more common type of prostatitis, called nonbacterial prostatitis, can be harder to treat and last a long time. Prostatitis is the most common prostate problem for men younger than 50.
High PSA Levels From Medical Procedures
“Anything that traumatically interferes with the architecture around the prostate gland can make PSA go up,” says John Milner, MD, FRCS, an assistant professor of urology at Loyola University’s Stritch School of Medicine in Chicago. “One of the most common causes of significantly high PSA from this type of trauma is the placing of a catheter into the bladder.”
Another cause is a prostate or bladder exam that involves passing a scope or taking a biopsy. “Since it takes about two to three days for PSA to go down by half, you should wait about two to three weeks after this type of trauma to do a PSA test.”
High PSA Levels From BPH
Benign prostatic hypeplasia (BPH) is an enlargement of the prostate gland, but it’s not prostate cancer. “BPH means more cells, so that means more cells making PSA,” explains Dr. Castle.
BPH may not need to be treated unless it is causing frequent or difficult urination. BPH is the most common prostate problem in men over age 50. Your doctor may be able to tell the difference between BPH and prostate cancer by doing a digital rectal exam. BPH usually causes abnormal PSA tests in the 4 to 10 range.
High PSA Levels From a Urinary Tract Infection
“Any infection near the prostate gland, including a urinary tract infection, can irritate and inflame prostate cells and cause PSA to go up,” says Dr. Milner. If you’ve been diagnosed with a urinary tract infection, be sure to wait until after the infection has cleared up before getting a PSA test. In men, most urinary tract infections are caused by bacteria and respond well to antibiotics. Be on the alert: BPH increases your risk for a urinary tract infection.
High PSA Levels as You Get Older
Even without any prostate problems, your PSA levels can go up gradually as you age. “At age 40, a PSA of 2.5 is the normal limit,” says Milner. “By age 60, the limit is up to 4.5; by age 70, a PSA of 6.5 could be considered normal.” Even so, a study done in Sweden and reported in the medical journal BMJ found that a low PSA at age 60 is especially welcome news. In 1,167 men who were followed from age 60 to age 85, those with a PSA at or below 1 ng/ml at age 60 had only a 0.2 percent chance of dying from prostate cancer.
High PSA Levels After Sex
“Ejaculation can cause a mild elevation of your PSA level, and so can having a digital rectal exam,” explains Milner. “These types of PSA elevations are usually not enough to make a significant difference unless your PSA is borderline. PSA should return to normal in two to three days.” Doctors will usually draw blood for a PSA level before doing a rectal exam. Ask your doctor if you should avoid ejaculation for a few days before a PSA test.
High PSA Levels From Riding Your Bike
There have been occasional studies that link prolonged bike riding to an increase in PSA levels, but others haven’t found such a connection. “You would probably have to be a Lance Armstrong-type bike rider to worry about bike riding and a significant rise in your PSA,” says Castle. “The most important thing to know about PSA is that it is still a really important screening test for prostate cancer, and prostate cancer is still the number two cancer killer behind lung cancer for men.”